Page 97 - JSOM Summer 2020

Quality Assurance in Tactical Combat Casualty Care
for Medical Personnel Training

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Dominique J. Greydanus, SOF ATP ; Lyndsey L. Hassmann, MPH ;
Frank K. Butler, MD *
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ABSTRACT
At present, however, there is no systematic, comprehensive graded trauma lanes and autologous blood transfusion train-
quality assurance program for TCCC training throughout the ing to the core JTS TCCC-MP curriculum. The post-course
DoD. Individual courses and instructors may or may not use written testing also needs to use the standardized TCCC fund
all of the materials in the JTS-approved curriculum; they may of knowledge questions and the TCCC Critical Decision Case
or may not add content that is not part of the JTS curriculum; Study questions developed by the JTS. Finally, there is a need
and they may or may not add additional training in the form to establish a systematic and standardized quality assurance
of advanced simulation, hands-on training with moulaged program to ensure that TCCC training programs are carried
casualties, graded trauma lanes, or live-tissue training. A re- out in accordance with the JTS-recommended TCCC curricu-
cent pilot appraisal of four Tactical Combat Casualty Care for lum. This program would best be performed as a new function
Medical Personnel (TCCC-MP) training courses found that of the CoTCCC with dedicated TCCC course appraisers.
TCCC-MP courses are not presenting all of the course mate-
rial recommended by the Joint Trauma System (JTS), despite Keywords: Tactical Combat Casualty Care; TCCC; training;
TCCC training having been mandated by the Department simulators; live tissue training; battlefield trauma care
of Defense (DoD) for all US military personnel. Some of the
omitted material is essential to ensuring that students are fully
prepared to perform TCCC on the battlefield. Further, there Introduction
was incorrect messaging presented in the TCCC-MP courses
that were appraised, some of which, if actually reflected in the TCCC Background
care provided on the battlefield, would likely result in adverse Tactical Combat Casualty Care (TCCC) began as a Naval Spe-
casualty outcomes. Other aspects of the TCCC messaging pre- cial Warfare Biomedical Research Program project intended to
sented in the appraised courses that is not at present part of review battlefield trauma care as it was practiced in the US
the JTS-approved curriculum might, however, be appropriate military in 1992. This research effort was conducted in part-
for inclusion into the TCCC Guidelines and the course cur- nership with the Uniformed Services University and produced
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riculum. Examples of material that should be considered for a then-novel set of evidence-based, best-practice battlefield
incorporation into the TCCC curriculum include modifying trauma care recommendations known as the TCCC Guidelines
the method of tranexamic acid (TXA) administration (slow that were first published in 1996. These recommendations
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IV push vs the currently recommended 10-minute infusion) were not implemented by most of the US Military in the inter-
and a better technique for securing of the new CAT Genera- val from 1996 to 2001, but, over the course of the 19 years that
tion 7 tourniquets after application. The course appraiser also followed the initiation of US combat action in Afghanistan in
noted that there were a number of excellent videos of actual 2001, TCCC was implemented first in Special Operations units
TCCC interventions being performed that are not part of the and subsequently throughout the US Military. These novel bat-
current JTS-approved TCCC-MP curriculum. These videos tlefield trauma care concepts have proven remarkably effective
should be forwarded to CoTCCC staff and the Joint Trauma in reducing preventable deaths among combat casualties. 1,4–11
Education and Training (JTET) branch of the JTS for consid- As a result of the proven merits of using TCCC concepts to
eration as potential additions to the TCCC-MP curriculum. care for the combat wounded, the DoD mandated TCCC as
Consideration should also be given to the inclusion of addi- the US Military standard for battlefield trauma care in 2018
tional TCCC training modalities such as advanced simulators, and mandated that all service members be trained in TCCC. 12
moulaged casualties, graded trauma lanes, autologous blood
transfusion training, and the use of live-tissue training (when TCCC has transformed the DoD’s approach to battlefield
logistically feasible) for selected course items such as surgical trauma care through a new approach to developing advances
airways. Further, the 16-hour training time currently allotted in prehospital combat casualty care: (1) ongoing reviews of the
for TCCC-MP training was found to be insufficient to present published prehospital trauma care literature; (2) analysis of US
all of academic material and testing contained in the existing military combat casualty outcomes through the Joint Trauma
TCCC-MP curriculum. A 5-day course should be considered System (JTS) performance improvement process; (3) develop-
to include the entire JTS-recommended curriculum and to add ing methodology to routinely incorporate direct feedback from
*Correspondence to fkb064@yahoo.com
1 Mr Greydanus is a former Special Forces 18-D medic. He led the very successful USSOCOM/USAISR TCCC Transition Initiative in 2005–2007.
He currently works for the Joint Trauma System. Ms Hassman is an epidemiologist with a background in infectious disease epidemiology, infec-
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tion control, and statistical analysis. She currently works for the Joint Trauma System. Dr Butler is a former Navy SEAL platoon commander,
ophthalmologist, Navy undersea medical officer, and former command surgeon for USSOCOM. For 11 years, he was the chairman of the DoD
Committee on TCCC.
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